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Morning Report

Morning Report. Acute Ataxia 8/31/09 Lorena Muñiz, MD. Definitions. Ataxia: From Greek ataktos : without order. Failure of muscular coordination. Pathologic abnormality of organization or modulation of movement.

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Morning Report

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  1. Morning Report Acute Ataxia 8/31/09 Lorena Muñiz, MD

  2. Definitions • Ataxia: From Greek ataktos: without order. Failure of muscular coordination. Pathologic abnormality of organization or modulation of movement. Disturbances in the control of body posture, motor coordination, speech control and eye movements.

  3. Dizziness:impairment in spatial perception and stability, considered imprecise. • Vertigo: sensation of spinning or having one's surroundings spin about them.

  4. Dysmetria: From English difficult to measure. Lack of coordination of movement typified by the undershoot and/or overshoot of intended position with the hand, arm, leg, or eye.

  5. Dysdiadochokinesia: From Greek dys "bad", dia "across", docho "receive", kinesia "movement“. Inability to perform rapid, alternating movements.

  6. Dysarthria: Motor speech disorder resulting from neurological injury, characterised by poor articulation • Nystagmus: form of involuntary eye movement characterized by alternating smooth pursuit in one direction and rapid movement in the other direction.

  7. Opsoclonus: Rapid, involuntary, multivectorial (horizontal and vertical), unpredictable, conjugate fast eye movements. • Myoclonus: Brief, involuntary twitching of a muscle or a group of muscles.

  8. Romberg's test:assess the dorsal columns of the spinal cord.Indication of loss of the sense of position, patient loses balance when standing erect, feet together, and eyes closed. +Romberg: ataxia is sensory in nature, depending on loss of proprioception. – Romberg: ataxia is cerebellar.

  9. Types of Ataxia • Cerebellar ataxia • Vestibulocerebellum impaired balance and control of eye movements, postural instability. • Spinocerebellum wide-based "drunken sailor" gait. 3. Cerebrocerebellum disturbances in carrying out voluntary, planned movements.

  10. Sensory ataxia: Loss of proprioception (joint position sense), dysfunction of the dorsal columns of the spinal cord, spinal nerve roots or peripheral nerves. • Vestibular ataxia: Loss of balance, in acute and unilateral cases is associated with prominent vertigo, nausea and vomiting.

  11. Etiology • Infectious/immune-mediated cerebellar disorders • Acute cerebellar ataxia* • Post infectious cerebellitis • Acute demyelinating encephalomyelitis • Systemic infections • Brainstem encephalitis • Multiple sclerosis

  12. Toxic • Alcohol • Anticonvulsants (phenytoin, carbamazepine) • Benzodiazepines • Barbiturates • Antihistamines • Lithium • Heavy metals (lead, mercury, thallium)

  13. Mass lesions • Tumors: brain stem, cerebellum • Vascular lesions (AVM) • Abscesses • Hydrocephalus • Trauma • Head • Neck (vertebral artery dissection)

  14. Vascular events • Stroke, hemorrhage • Paraneoplastic disorders • Opsoclonus-myoclonus syndrome: Occult Neuroblastoma or ganglioneuroblastoma • Sensory ataxia • Miller Fisher syndrome: ataxia, areflexia, ophtalmoplegia(vertical gaze)

  15. Paretic ataxia • Other neurologic disorders • Basilar migraine: vertigo, hemiparesis, cranial nerve dysfunction, N/V/HA • Benign paroxysmal vertigo • Seizures • Inborn error of metabolism • Functional

  16. Work up • History: • Prior or current symptoms of infection. • Recent immunizations. • Headaches, vomit, diplopia. • ROS. • Drug ingestion. • Head on neck trauma. • Similar episodes in past or in family.

  17. Physical exam • Complete neurological exam • Mental status • Cranial nerves • Cerebellar testing • Sensation • Strength • Meningeal signs • Reflexes • Gait

  18. Initial ancillary tests • Laboratory • Urine/serum drug screen/level • CBC • Electrolytes • Imaging • CT brain • MRI brain

  19. Thank you!

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